Provider Demographics
NPI:1437115763
Name:BLANKENSHIP, JOE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:DAVID
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 GREYSTONE SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3589
Mailing Address - Country:US
Mailing Address - Phone:731-664-5150
Mailing Address - Fax:731-664-5059
Practice Address - Street 1:3000 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3589
Practice Address - Country:US
Practice Address - Phone:731-664-5150
Practice Address - Fax:731-664-5059
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN165546OtherUNISON HEALTH PLAN
TN7030OtherTLC
TN3842457Medicaid
TN4102818OtherBCBST
TN3842457Medicaid
TN4102818OtherBCBST